Methods for diagnosing and monitoring treatment ADHD by assessing the dopamine transporter level

ABSTRACT

A method of diagnosing attention deficient-hyperactivity disorder (ADHD) in a human patient by assessing the level of dopamine transporter in at least one region of the patient&#39;s central nervous system, where an elevated level of dopamine transporter in the patient is indicative of ADHD. In embodiments of the invention, assessment of dopamine transporter levels includes assessing binding of a dopamine transporter ligand to the dopamine transporters using PET or SPECT.

[0001] The present application claims the benefit of: U.S. applicationSer. No. 09/605,621, filed on Jun. 28, 2000, which claims the benefit ofprovisional application No. 60/141,540, filed on Jun. 28, 1999; U.S.provisional application No. 60/300,133, filed on Jun. 22, 2001, U.S.provisional application No. 60/307,744, filed on Jul. 25, 2001; U.S.application Ser. No. 08/552,584, filed Nov. 3, 1995, which issued onJan. 19, 2001 as U.S. Pat. No. 5,853,696; U.S. application Ser. No.09/314,441, filed on May 19, 1999 and 09/671,534, filed on Sep. 27,2000, which are both divisional applications of U.S. application number08/893,921, filed Jul. 11, 1997, which issued on Sep. 7, 1999 as U.S.Pat. No. 5,948,933; and U.S. application Ser. No. 09/568,106, filed May10, 2000, which claims the benefit of U.S. provisional application No.60/133,761, filed May 12, 1999, all incorporated herein by reference.

FEDERALLY SPONSORED RESEARCH

[0002] This invention was made at least in part with government funding(NIH grants: DA06303, DA09462, NS30556, DA11558, and DA00304) and thegovernment has certain rights in the inventions.

FIELD OF THE INVENTION

[0003] The present invention relates to the dopamine transporter, toimaging the dopamine transporter, and to diagnosing and monitoring ADHD.

BACKGROUND OF THE INVENTION

[0004] Attention Deficit Hyperactivity Disorder (ADHD) is characterizedby heterogeneous problems with inattention, impulsivity, andhyperactivity. Mercugliano, 1999, Pediatr.Clin.North Am. 46:831-843;Faraone, et al., 1999, “The neurobiology of attention deficithyperactivity disorder” in Neurobiology of Mental Illness, Charney, etal., eds., Oxford University Press, New York, pp. 788-801. It is one ofthe most commonly diagnosed behavioral disorders in children, affectingapproximately 3-5% of school age children. Faraone, et al., 1999, supra;1998, “Diagnosis and Treatment of Attention Deficit HyperactivityDisorder (ADHD)” NIH Consensus Statement 16:1-42. In addition, it isestimated that the majority of patients with ADHD will continue to havesignificant symptoms as adults. NIH Consensus Statement, supra. Adultswith ADHD tend to have fewer problems with hyperactivity, but moreproblems with inattention and distractibility. Many patients have ADHDin conjunction with other psychiatric disorders (co-morbidities),including depression, anxiety, conduct disorders, oppositional disorder,obsessive compulsive disorder, and alcohol and/or substance abuse.Biederman, et al., 1993, Am.J.Psychiatry 150:1792-1798. The symptoms ofinattention, impulsivity, and hyperactivity significantly interfere withschool and job performance and social interactions affecting both peersand families. Faraone, et al., 1999, supra. ADHD is typically treatedwith stimulant medications, although there is considerable controversyregarding the long-term use of these medications in children.Mercugliano, 1999, supra; NIH Consensus Statement, supra; Spencer, etal., 1996, J.Am.Acad.Child Adolesc.Psychiatry 35:409-432 [see comments].

[0005] The diagnosis of ADHD has evolved over the past fifty years asthe syndrome has become better characterized. Although the currentdiagnostic criteria described in Diagnostic and Statistical Manual ofMental Disorders-IV (DSM-IV) are generally accepted, the validity of thediagnosis in many children and adults has been questioned because thediagnosis is based on subjective clinical evaluations. Spencer, et al.,1994, Harv.Rev.Psychiatry 1:326-335. A reliable diagnosis of ADHD can bemade by expert psychiatrists or psychologists using standardizedstructured interviews and neuro-psychiatric tests to adequately assessthe patient and rule out confounding co-morbidities. However, thediagnosis may be less reliable when made by inadequately trained orinexperienced practitioners. In addition, it is estimated that at least40% of adult patients with a probable diagnosis of ADHD do not meetstrict DSM-IV criteria, largely because of the criterion that symptomsbegin before seven years of age. Applegate, et al., 1997, J.Am.Acad.Child Adolesc.Psychiatry 36:1211-1221; Barkley, et al., 1997, J.Am.Acad.Child Adolesc.Psychiatry 36:1204-1210 [see comments]. Thus, it appearsthat the clinical diagnosis of ADHD results in both the over-andunder-diagnosis of large numbers of patients. An independent andobjective biological test to support the clinical diagnosis of ADHDwould be beneficial. NIH Consensus Statement, supra. However, there hasbeen doubt expressed by physicians that structural imaging studies,e.g., using single photon emission tomography (SPECT), would prove to beuseful for the evaluation or management of ADHD. Zametkin, et al., 1998,J. Clin. Psychiatry 59 (suppl. 7): 17-23.

[0006] Attention deficit-hyperactivity disorder (ADHD) is a recognizedsyndrome characterized by a relatively high incidence in children withpersistence into adulthood. Some research suggests that ADHD has agenetic component. Biederman et al., 1995, Am. J. Psychiatry152(3):431-35; Arnold et al., 1997, Arch. Gen. Psychiatry 54:865-70.Paradoxically, stimulant drugs such as methylphenidate, d-amphetamnineand pemoline are effective medications for treating ADHD in children andadults. Seeman and Madras, 1998, Molecular Psychiatry 3:385-96; Arnoldet al., 1997, supra; Greenhill, et al., 1999, J. Am. Acad. ChildAdolesc. Psychiatry, 38(5):503-12; Wilens, et al., 1992, PsychiatricClinics of N. Am. 15(1): 191-222.

[0007] Increased recognition of the disorder has led to increasedprescription of stimulant medications for treating ADHD. There isconcern about the possibility of over-diagnosis of ADHD and resultingunnecessary treatment with stimulant drugs that have inherent potentialfor abuse. Conversely, if ADHD is underdiagnosed, patients who could behelped may go untreated. Thus, improved methods and products fordiagnosis of ADHD and assessment of the effect of treatment of ADHD aredesired.

SUMMARY OF THE INVENTION

[0008] We have recognized that the dopamine transporter (DAT) in thehuman brain is a useful protein for diagnosing and monitoring the courseof ADHD. Although ADHD appears to result from multifactorial genetic,neurological, and environmental factors, recent data suggest thatdysregulation of catecholamine transmitters, including dopamine andnorepinephrine, in the brain may be the underlying mechanism of ADHD.There is additional evidence to suggest that dopamine transporters(DATs) are causally involved in the pathogenesis of ADHD. We haveconcluded that the involvement of DATs in ADHD is suggested by the factthat stimulant medications, such as methylphenidate (Ritalin™), pemoline(Cylert™), and dextroamphetamine (Adderall™, Dexadrine™), that arecurrently used to treat ADHD specifically target dopamine transportersin the brain. The involvement of DATs is also supported by geneticstudies that demonstrate a genetic linkage between certain alleles ofDAT genes and familial or hereditary forms of ADHD. Although thespecific relationship of DATs to ADHD is still not understood, it islikely that over expression or altered function of DATs is associatedwith ADHD. Thus, an objective measurement of DATs in the brain canfacilitate the diagnosis, assessment and investigation of the mechanismof ADHD.

[0009] Various dopamine transporter imaging agents can be used to assaythe dopamine transporter as a biological marker for ADHD. Such imagingis used to diagnose ADHD and to monitor it, e.g. as the patient maturesand/or is treated over time.

[0010] The present invention provides methods of diagnosing attentiondeficient-hyperactivity disorder (ADHD) in a human patient by assessingor determining dopamine transporter activity in at least one region ofsaid patient's central nervous system.

[0011] The method preferably comprises administering to the patient alabeled dopamine transporter ligand and the assessment comprisesdetermining the amount of labeled dopamine transporter ligand that isbound to dopamine transporter. The amount of labeled dopaminetransporter ligand that is bound to dopamine transporter is comparedwith a control. An elevated level of dopamine transporter in saidpatient is indicative of ADHD. PET or SPECT imaging are particularlypreferred assessment techniques. The dopamine transporter ligandcomprises a compound that binds to the dopamine transporter. Examples ofsuitable ligands include (¹¹C)CFT ((¹¹C)WIN 35,428), (¹²³I)Altropane™,and (¹⁸F)CFT. Ligands, particularly suitable for use in PET, include[¹¹C]Altropane™. Ligands, particularly suitable for use in SPECT,include technetium-labeled phenyltropane probes, such as(^(99m)Tc)technepine™, O-1505, and similar compounds. Other examples ofcompounds useful in the methods of the present invention are describedin U.S. Pat. Nos. 5,506,359, 5,770,180, 5,948,933 and 6,171,576, and inU.S. application Ser. No. 09/568,106 filed May 10, 2000, the disclosuresof which are hereby incorporated by reference. The portion of thepatient's central nervous system for assessment is preferably a portionof the human brain, e.g., the striatum.

[0012] Assessing dopamine transporter to determine dopamine transporterlevels can include assessing dopamine transporter availability orbinding potential. For example, in a method wherein dopamine transporteravailability is assessed, dopamine transporter availability in a patientis compared with the dopamine transporter availability in a control,wherein a higher doparnine transporter availability in the patient isindicative of ADHD. Similarly, when dopamine transporter bindingpotential is measured the dopamine transporter binding potential in thepatient is compared with the dopamine transporter binding potential in acontrol, and a higher dopamine transporter binding potential in thepatient is indicative of ADHD.

[0013] The present invention also provides a method of determining theeffectiveness of an ADHD treatment for a human patient. The methodincludes determining or assessing an initial dopamine transporter leveli, at least one region of the patient's central nervous system, treatingthe patient and, then, determining or assessing dopamine transporterlevel in the same region, e.g., after two or more weeks of treatment.The initial and subsequent dopamine transporter levels are then comparedto determine or assess the effectiveness of treatment. A decrease indopamine transporter levels indicates that the treatment is effective.In preferred methods, a labeled dopamine transporter ligand isadministered to the patient before assessing the initial dopaminetransporter level and, if necessary, also before assessing thesubsequent dopamine transporter level. In this method, the assessmentcomprises determining the amount of labeled dopamine transporter ligandthat is bound to doparnine transporter. The subsequent step of assessingdopamine transporter levels can be repeated more than one time, in orderto follow the course of treatment, as necessary.

[0014] The treatment of ADHD can include, for example, administration ofa pharmaceutical, such as methylphenidate, pemoline, or an amphetamine.The assessment of effectiveness can include imaging by PET or SPECTtechniques.

[0015] The effectiveness of a treatment can be determined by assessingdopamine transporter availability before treatment, and comparing thisvalue with the dopamine transporter availability in subsequentassessment steps. A lower dopamine transporter availability in thesubsequent assessment indicates that the treatment is effective.Similarly, the binding potential can be used to assess dopaminetransporter levels, where the dopamine transporter binding potential inthe initial assessment is compared with the binding potential in thesubsequent assessment and a lower dopamine transporter binding potentialin subsequent assessments indicates that the treatment is effective.

[0016] The invention also provides a method of determining whether anindividual has a heightened probability of having ADHD. The methodincludes assessing the level of dopamine transporter in at least oneregion of the patient's central nervous system and comparing thepatient's dopamine transporter level to a predetermined normal dopaminetransporter level. A higher than normal level is indicative of aheightened probability of having ADHD. A labeled dopamine transporterligand is administered before the assessing step, and the assessmentstep comprises determining the amount of labeled dopamine transporterligand that is bound to dopamine transporter.

[0017] The invention further provides a method of monitoring theprogress of a treatment for ADHD in a human patient. The method includesdetermining or assessing the level of dopamine transporter in at leastone region of the patient's central nervous system a plurality of timesduring the treatment. Comparing the results of dopamine transporterlevel in the same region of the brain at various times during treatmentenables one to monitor the progress of treatment. In this method,preferably a labeled dopamine transporter ligand is administered to thepatient and the dopamine transporter level is assessed by measuring theamount of labeled dopamine transporter ligand that is bound to dopaminetransporter. The amount of bound labeled dopamine transporter ligand ismeasured by any method of imaging, preferably using PET or SPECTimaging.

[0018] The methods of the present invention can provide one or more ofthe following advantages. For example, assessing dopamine transporterlevels allows an objective, biologically based diagnosis of ADHD.Diagnosis based on dopamine transporter levels can be used for patientsof all ages and both sexes. The method of the present invention areuseful in diagnosing ADHD in adults, as well as in children. Preferredimaging agents used to assess dopamine transporter levels, for example,(¹²³I)Altropanem, are safe and well tolerated by patients.

[0019] Other features and advantages of the invention will be apparentto those skilled in the arts from the following description of thepreferred embodiments and from the claims.

[0020] As used herein, the term “dopamine transporter ligand” means acompound that binds to the dopamine transporter. Preferred compoundsbind selectively to the dopamine transporter in preference to theseratonin transporter.

DETAILED DESCRIPTION OF THE INVENTION

[0021] We have discovered that abnormal levels of the dopaminetransporter in human brain is indicative of ADHD. Assessing dopaminelevels in the brain, therefore, can confirm a diagnosis of ADHD, or canassist in monitoring treatment of ADHD.

[0022] Dopamine Transporter Assessment Techniques

[0023] Assessing dopamine transporter levels can be performed byassessing dopamine transporter availability using, e.g., PET (positronemission tomography) or SPECT (single photon emission computedtomography). To measure dopamine transporter availability, a labeledprobe that targets the transporter is introduced into the brain, e.g.,intravenously, and PET or SPECT is performed. From the PET or SPECTimages, the density of the doparnine transporter is quantified bymeasuring the binding potential, where binding potential is defined asthe maximum number of binding sites, B_(max), divided by a dissociationconstant, K_(d), where K_(d) is related to affinity.

[0024] Imaging agents that target the dopamine transporter include(¹¹C)Altropane™, (¹¹C or ¹⁸F)WIN 35,428 ((¹¹C)CFT), (¹²³I)Altropane™,(^(99m)Tc)O-1505, (^(99m)Tc)technepine™, and similar compounds. Theseagents bind the dopamine transporter with varying affmities, allowingmultiple, dissimilar assessments to be performed. Structures, synthesis,and/or sources of some of the above agents are described in, e.g.,Fischman et al., 1998, Synapse 29:125-41 ((¹²³I)Altropane™); Madras etal., 1996, Synapse 22:239-46; Meltzer et al., 1993, J. Med. Chem.36:855-62; and Milius et al., 1990, J. Medicinal Chem. 34:1728-31, eachof which is incorporated herein by reference. Another useful compoundincludes ¹²³I Ioflupane (DatSCAN) from Nycomed-Amersham.

[0025] Compounds that are useful as imaging agents in the methods of thepresent invention includes compounds described in pending applicationU.S. Ser. No. 09/568,106. These compounds have a tropane compound linkedthrough the N atom at the 8-position to a chelating ligand capable ofcomplexing a technetium or rhenium radionuclide to produce a neutrallabeled complex that selectively binds to the dopamine transporter. Thetropane compounds bind to the dopamine transporter. These compounds arerepresented by the following structural formula:

[0026] wherein R₁ is α or β and is selected from COOR^(a), COR^(a), andCON(CH₃) OR^(a);

[0027] R₂ is α or β and is selected from C₆H₄X, C₆H₃XY, C₁₀H₇X, andC₁₀H₆XY;

[0028] R^(a) is selected from C₁-C₅ alkyl, e.g. methyl, ethyl, propyl,isopropyl, etc.;

[0029] X and Y are independently selected from R^(a), H, Br, Cl, I, F,OH, and OCH₃;

[0030] L is-(CH₂). where n is an integer from 1 to 6, or-(CH₂)_(n)(aryl, arylalkyl, ethenyl or ethynyl)-(CH₂)_(m) where the sum of n plusm is an integer from 1 to 6; and

[0031] Ch is a tridentate or tetradentate chelating ligand that forms aneutral complex with technetium or rhenium.

[0032] R₁ and R₂ can be in the α or β configuration. Further, R₁preferably can be substituted at the C₂ or C₄ when the tropane has a 1Ror 1S configuration, respectively.

[0033] Any tropane compound of the general formula II is useful in thepresent invention so long as it binds to DAT. Examples of particularlyusefuil tropanes are: 2-carbomethoxy-3-(4-fluorophenyl)-N-methyltropane(“WIN 35,428”) (Clarke, R.L., et al., J. Med. Chem. 1973, 16, 1260-1267)which binds potently (IC₅₀=11.0 nM) and with specificity to the DAT(Meltzer, P.C., et al., J. Med. Chem. 1993, 36, 855-862);2-carbomethoxy-3-(3,4-dichlorophenyl)-N-methyltropane (“O-401”;IC₅₀=1.09nM) (Meltzer, P.C., et al., J. Med. Chem. 1993, 36, 855-862).Tropane analogs that have a 3α-group are of the boat configuration.Other tropanes having a 3β-oriented group are of the chairconfiguration.

[0034] Chelating ligands include any tridentate or tetradentate ligandthat binds technetium or rhenium to form a neutral complex. Thechelating ligand is covalently attached to the linker L, as describedbelow. Preferred chelating ligands contain a plurality of N or S atomsfor complexing with the radionuclide.

[0035] Examples of suitable ligands are the N₂S₂ compounds representedby the following structural formulas:

[0036] wherein R, R⁶, and R¹⁰ are each selected from hydrogen,substituted or unsubstituted lower alkyl, alkylR⁹, or-COR⁹ where R⁹ isselected from hydroxy, substituted lower alkoxy, substituted orunsubstituted amino, glycine ester, halide (chloro, bromo, iodo) or OR(OR is a leaving group such as mesylate, triflate, or tosylate) or anactivated leaving group; R¹ is selected from hydrogen, or substituted orunsubstituted lower alkyl; R² and R³ are each selected from hydrogen ora thiol protecting group, or an inter or intramolecular disulfide; andR⁴, R⁵, R⁷ and R⁸ are each selected from hydrogen or lower alkyl.

[0037] When R, R⁶ or R¹⁰ is a carboxylic acid derivative, R⁹ can be anactivated leaving group. For purposes of this invention the leavinggroup R⁹ is defined such that (compound)-COR⁹ is an acylating agent.Examples of activated leaving groups suitable for the practice of thisinvention include, for example: halide; substituted or unsubstitutedaryloxy groups such as phenoxy, pentachlorophenoxy, etc,;oxy-heterocyclic groups such as N-oxy-succinimido, etc.; mercapto; loweralkylthio; arylthio; oxyphosphonium; and other groups known to thoseskilled in the art to be useful as leaving groups.

[0038] R² and R³ can be hydrogen or any known thiol protecting group.Examples of such groups include lower alkylaminocarbonyl such asethylaminocarbonyl, lower alkanoylaminomethyl, aroylaminomethyl,t-butyl, acetamidomethyl, arylmethyl such as triphenylmethyl (trityl)and diphenylmethyl, aroyl such as benzoyl, aryloxycarbonyl such asphenoxycarbonyl, arylloweralkoxycarbonyl, preferablyarylmethoxycarbonyl, benzyloxycarbonyl, and lower alkoxycarbonyl such ast-butoxycarbonyl. Preferred thiol protecting groups include trityl,t-butyl, diphenylmethyl, acetamidomethyl and benzoyl and an inter orintramolecular disulfide.

[0039] The term “lower alkyl” when used herein designates aliphaticsaturated branched or straight chain hydrocarbon monovalent substituentscontaining from 1 to 6 carbon atoms such as methyl, ethyl, isopropyl,n-propyl, n-butyl, etc., more preferably 1 to 4 carbons. The term “loweralkoxy” designates lower alkoxy substituents containing from 1 to 6carbon atoms such as methoxy, ethoxy, isopropoxy, etc., more preferably1 to 4 carbon atoms.

[0040] The terms substituted lower alkyl or substituted lower alkoxywhen used herein include alkyl and alkoxy groups substituted withhalide, hydroxy, carboxylic acid, or carboxamide groups, etc. such as,for example, —CH₂OH, —CH₂CH₂COOH, —CH₂CONH₂, —OCH₂CH₂OH, —OCH₂COOH,—OCH₂CH₂CONH₂, etc.

[0041] The term substituted amino when used herein includes such groupsmono or di and tri-substituted with lower alky, and-NH₃+or mono, di andtri-substituted ammonium groups substituted with lower alkyl with apharmacologically suitable anion.

[0042] The term glycine ester as used herein means the lower alkylesters of glycine, preferably the methyl and ethyl esters.

[0043] These chelating ligands can be complexed with a radionuclide,e.g., technetium, to form the following complexes:

[0044] where the R groups are defined as above.

[0045] These compounds use chelating ligands that are formed frommonoaminomonoamide compounds having structures of formula V, VI or VII,e.g.,N-{2-((2-((triphenylmethyl)-thio)-ethyl)amino)acetyl}-S-(triphenylmethyl)-2-aminoethanethiol(″MAMA′″). Any organic linker having a backbone chain length of 1 toabout 6 carbon atoms can be used to attach the chelating ligand,typically through its nitrogen, sulfur, R, R¹ or R⁶, to the 8-nitrogenatom of the tropane ligand (which binds the dopamine transporter).Examples of linkers include —(CH₂)_(n) where n is an integer from 1 to6, or —(CH₂)_(n)-(aryl, arylalkyl, ethenyl or ethynyl)—(CH₂)_(m) wherethe sum of n plus m is an integer from 1 to 6.

[0046] An example of a compound having the above structure includesTechnepine™, (O-861), which comprises a tropane,2-carbomethoxy-3-(4-fluorophenyl)-N-methyltropane, also known as WIN35,428, joined at the N-position to the MAMA′complexing ligand.

[0047] As mentioned above, another useful imaging agent is Altropane™.This and related compounds are described in U.S. Pat. No. 5,493,026 andinclude compounds having the following formula:

[0048] wherein the following condition is imposed on that formula:

[0049] R is —CH₃, —CH₂CH₃ (α configuration; β configuration or both),—CH(CH₃)₂, —(CH₂)_(n)CH₃, —(CH₂)_(n)C₆H₄X, —C₆H₄X, —C₆H₅, —OCH₃,—OCH₃CH₂, —OCH(CH₃)₂, —OC₆H₅, —OC₆H₄X, —O(CH₂)_(n)C₆H₄X, or—(CH₂)_(n)CH₃; wherein X is —Br, —Cl, —I, —F, —OH, —OCH₃, —CF₃, —NO₂,—NH₂, —CN, —NHCOCH₃, —N(CH₃)₂, —(CH₂)_(n)CH₃, CHOCH₃, or —C(CH₃)₃ and nis between 0 and 6 inclusive.

[0050] Other compounds can have the same formula, except that thesubstituent on the N-allyl group can be any halogen, preferably-I or-F.Other useful compounds are characterized as follows: a) the 2substituent is in the β position; b) the 3 substituent is in the βposition; c) R is —O—CH₃; the 8 substituent is either the E isomer orthe Z isomer. More preferably the halo substituent on the N-allyl moietyis —I or —Br (particularly a radionuclide of —I or —Br); ¹⁸F providesalso a useful label. Most preferably, the compound is lodoaltropane:2-β-carbomethoxy-3-β-(4-fluorophenyl)-8-(3E-iodopropen-2-y1) nortropane.The compounds used in the present methods contain a radioactive label(particularly a gamma or position emitter such as ¹²³I, ¹²⁵I ¹⁸F or ¹¹C¹²³I is particularly preferred) or a ¹⁸F fluoro label as part of the3-halopropen-2-yl substituent.

[0051] Other techniques to identify anomalies in brains of ADHD patientsinclude SPECT imaging to measure blood flow and functional MRI tomeasure regional metabolic function. Both techniques can demonstrateabnormal function of the frontal cortex.

[0052] Applications of Dopamine Transporter Assessments

[0053] Traditionally, ADHD is diagnosed by assessing a patient'scognitive and attentional slills. For example, according to theDiagnostic and Statistical Manual of Mental Disorders, 4th edition(DSM-IV), evidence of either inattention or hyperactivity andimpulsivity are required to support a diagnosis of ADHD. Under theDSM-IV standard, a finding of inattention must be supported by six ormore of the following symptoms, persisting for at least six months to adegree that is maladaptive and inconsistent with the patient's level ofdevelopment: (1) fails to give close attention to details; (2) hasdifficulty sustaining attention to activities; (3) does not listen whenspoken to directly; (4) does not follow through on instructions; (5) hasdifficulty organizing tasks; (6) avoids engaging in tasks that requiresustained mental effort; (7) loses things necessary for activities; (8)is easily distracted by extraneous stimuli; (9) is forgetful in dailyactivities. Similarly, under the DSM-IV standard, a finding ofhyperactivity and impulsivity must be supported by six or more of thefollowing symptoms, persisting for at least six months to a degree thatis maladaptive and inconsistent with the patient's level of development:(1) is fidgety; (2) leaves seat when expected to remain seated; (3) runsabout in situations in which it is inappropriate; (4) has difficultyplaying quietly; (5) acts as if “driven by a motor”; (6) talksexcessively; (7) blurts out answers before questions have beencompleted; (8) has difficulty taking turns; (9) interrupts or intrudeson others. When used to diagnose ADHD in adults, the above criteria aremodified slightly to apply to adult environments.

[0054] Diagnosis of ADHD using the DSM-IV standard is inherentlysomewhat subjective, leading to inconsistent diagnosis.

[0055] Assessment of dopamine transporter levels can complement, and insome cases, supplant, traditional ADHD diagnostic techniques. Thedopamine transporter level assessments using PET or SPECT provideobjective, biological criteria for diagnosing ADHD, and can be used,e.g., to confirm an ADHD diagnosis under the DSM-IV standard, to resolveconflicting diagnoses, or to call into question a diagnosis ornon-diagnosis of ADHD. Dopamine transport assessments can also be usedto refine subjective testing criteria for ADHD.

[0056] In addition, PET and SPECT imaging of the dopamine transportercan be used to monitor and adjust treatment of ADHD. For example,methylphenidate, a drug commonly used to treat ADHD, may occupy thedopamine transporter. Volkow et al., 1998, Am. J. Psychiatry155:1325-31. The effectiveness of methylphenidate treatment for aparticular patient could be monitored by assessing dopamine transporterlevels both before and after administration of methylphenidate. Forexample, dopamine transporter levels can be assessed immediately beforea treatment, and then, e.g., two weeks, months, or longer afteradministration of treatment. If the methylphenidate successfullyoccupies dopamine transporters, it will displace the radio-labeledprobe, decreasing the availability of dopamine transporter. Thedecreased availability of dopamine transporter will manifest asdecreased binding potential in the PET or SPECT images. Such objectivedata can assist a physician in determining the most effective drug andthe most effective dosage for a particular patient.

[0057] Dopamine transporter level assessments can also be used tomonitor treatment over the long term, and to help a physician andpatient determine whether treatment affects transporter levels andwhether treatment can be stopped.

[0058] Finally, dopamine transporter level assessments can identifyindividuals at risk for ADHD. Patients found to have elevated dopantinetransporter levels can, e.g., be referred for conventional ADHD testing.

[0059] Experimental Studies

[0060] Experimental data confirm the efficacy of diagnosing ADHD bydetecting elevated dopamine transporter levels.

EXAMPLE 1

[0061] SPECT imaging of the doparnine transporter with[¹²³I]Altropane™was conducted on six subjects previously diagnosed withADHD, and on control individuals without a diagnosis of ADHD.Altropane™, E-2β-carbomethoxy-3β-(4-fluorophenyl)-N-1(1-iodoprop-1-en-3)nortropane, is an iodo analog of N-allyl CFT (WIN 35,428), aphenyltropane analog. The molecular formula of Altropane™ isC₁₈H_(2l)NO₂F. Before administration to human subjects or patients,Altropane™ was labeled with (¹²³I), a gamma-emitting isotope with ahalf-life of 13.2 hours. For each individual tested, greater than 1 mCiof (¹²³I)Altropane™ was administered by intravenous injection at theonset of imaging. Images of the striatum were collected and analyzed bya radiologist to determine striatal binding potentials. In general, themethodology used for the SPECT imaging was the same as the methodsdescribed in Fischman et al., 1998, Synapse 29:125-41, which isincorporated herein by reference.

[0062] The results of the imaging of ADHD patients are summarized belowin Table 1: TABLE 1 ADHD Patients INDIVIDUAL AGE BINDING POTENTIALADHD-1 34 2.98 ADHD-2 45 2.34 ADHD-3 24 2.71 ADHD-4 53 2.33 ADHD-5 512.16 ADHD-6 41 3.51 MEAN 41 2.67

[0063] These six ADHD individuals show elevated binding potential, and,therefore, elevated dopamine transporter levels compared to expectedlevels for aged matched normal individuals, which may range, generally,between about 1.0 and 2.2.

EXAMPLE 2

[0064] Pre-clinical in vivo and in vitro studies performed in monkeysdemonstrated that Altropane™ preferentially binds to dopamine rich areasof the striatum with a density that is within the range reported for thedopamine transporter. Madras, et al., 1998, Synapse 29:105-115.Altropan™ has demonstrated high selectivity for the dopaminetransporter, compared to the seratonin transporter. Madras, et al.,1998, Synapse 29:93-104. Further, in vitro binding studies demonstratedthat Altropane™ binds to a specific high-affinity site on the dopaminetransporter. Elmaleh, et al., 1996, J.Nucl.Med. 37:1197-1202; Madras, etal., 1998, Synapse 29:116-127.

[0065] The overall objective of this study was to confirm the results ofa preliminary study and to further define the safety profile along withthe sensitivity and specificity of (¹²³I)-Altropane™ SPECT bindingpotentials in the diagnosis of adult patients with ADHD, as compared tohealthy volunteers without ADHD. The truth (“gold”) standard is theclinical diagnosis of ADHD made by an expert psychiatrist/psychologistusing structured diagnostic interviews and neuro-psychiatric testing,along with strict DSM-IV criteria for the diagnosis of ADHD, asdescribed by Biederman and colleagues. Biederman, et al. 1993, supra.

[0066] Diagnostic Assessments

[0067] Each underwent a standardized clinical assessment, as describedby Biederman, et al., that included psychiatric evaluation, structureddiagnostic interview, cognitive testing and neuropsychological battery,medical history and laboratory assessment. The clinical evaluation wasconducted by a clinician who knows and treats adult ADHD.

[0068] Structured Diagnostic Interview

[0069] 1) Structured Clinical Interview for DSM-IV (SCID) Adult DSM-IVDisorders

[0070] 2) Kiddie-Schedule for Affective Disorders and Schizophrenia(K-SADS-E) addition Childhood DSM-IV Disorders

[0071] Neuropsychological Battery

[0072] 1) KBIT, WRAT-3 (Measures verbal, performance and freedom fromdistractibility IQ. This assessment is measured at baseline only.)

[0073] 2) Rey-Osterrieth Complex Figure (Measures planning andorganization).

[0074] 3) Conners Continuous Performance Tests (Auditory and Visual),(Measures sustained attention, selective attention and susceptibility tointerference)

[0075] 4) Stroop (Measures susceptibility to interference)

[0076] Rating Scales

[0077] 1) Clinical Global Impression (CGI) Scale (NIMH, 1985).

[0078] 2) The ADHD Symptom Checklist Severity Scale. DuPaul, 1991,J.Clin.Child.Psychol. 20:245-253; Murphy, et al., 1996, Joumal ofAttention Disorders 1: 147-161.

[0079] 3) The Hamilton Depression Scale (the 21-item Hamilton DepressionScale (HAM-D) will be completed by the physician to evaluate depressivesymptoms). Hamilton, 1960, Journal of Neurological and NeurosurgicalPsychiatry 23:56-62.

[0080] 4) The Hamilton Anxiety Scale (the 14-item Hamilton Anxiety Scalewill be completed by the Physician to evaluate symptoms of anxiety).Hamilton, 1959, Br.J.Med.Psychol. 32:50-55.

[0081] 5) Beck's Depression Inventory (The 21-item Beck's DepressionInventory (BDI) will be completed by the physician to evaluatedepressive symptoms). Beck, et al., 1961, Arch. Gen.Psychiatry4:561-571.

[0082] SPECT Imaging with [¹²³I]-Altropane™

[0083] Subjects were given SSKI or Lugol's solution treatment todecrease thyroid exposure to ¹²³I. The dose was 5 drops PO once daily,beginning 24 hours before imaging, the day of imaging, and an additional1 to 3 days after injection, per the discretion of the investigator. Thetotal daily dose of SSKI or Lugol's should be 5 drops.

[0084] Procedures

[0085] 1) Perform pre-injection Brief Neurological Assessment

[0086] 2) Position the subject in the scanner with appropriate headimmobilization.

[0087] 3) Administer radiopharmaceutical over approximately thirty (30)seconds, followed by a 20 mL saline flush administered overapproximately thirty (30) seconds, such that the total infusion time forthe Altropane™ plus the saline flush is approximately sixty (60) seconds

[0088] 4) Acquire a series of consecutive two-minute SPECT scans.

[0089] 5) Perform post-injection Brief Neurological Assessmentapproximately 60 to 90 minutes after [¹²³I]-Altropane™ administration.

[0090] (¹²³I)-Altropane Administration and SPECT Imaging

[0091] Approximately 8 mCi [¹²³I]-Altropane™ was infused intravenouslyover approximately thirty (30) seconds, followed by a saline flush of 20mL administered over approximately thirty (30) seconds, such that thetotal time of administration of the Altropane™ and saline flush wasapproximately sixty (60) seconds. (Note: Volume for an 8 mCi injectioncan vary from approximately 5 to 20 ml.)

[0092] Each clinical dose of a sterile, pyrogen-free solution of[¹²³I]-Altropane for intravenous (i.v.) injection contained:(¹²³I)-Altropane™ 8 mCi [¹²³I] ˜15 ng Altropane™ Ethanol, U.S.P. 7% byvolume 0.9% Sodium Chloride for Injection, U.S.P. 90% by volume Waterfor Injection, U.S.P. 3% by volume

[0093] Effective head immobilization is very important for successfulimaging. The orbital meatal line was aligned with the plane of rotation.Dynamic SPECT imaging was begun immediately after completion of theinfusion. Approximately fifteen (15) SPECT studies were acquired insequence, starting immediately after the completion of [¹²³I]-Altropane™infusion. Each of the SPECT studies were acquired over a 2-minute periodfor a total of 60 minutes of imaging time, accounting for reset periodsbetween each SPECT study.

[0094] A transverse slice set from each of the 15 SPECT studies wasreconstructed using a Butterworth filter of order 4.0 and cut-off of0.26 cycles/pixel as suggested starting points, or equivalent. (Note:images should be optimized for each gamma camera used.) Attenuationcorrection was performed using the Chang Algorithm.

[0095] Primary Analyses

[0096] A comparison was made between the ADHD and non-ADHD subjects withrespect to baseline demographic and medical history data. For thequantitative variables the comparison used either a t-test or theWilcoxon rank sum test, as appropriate. For the qualitative variablesthe comparison was based on Fisher's exact test.

[0097] Quantitative Analysis of [¹²³I]-Altropane Images

[0098] An estimate of the striatal binding potential of[¹²³I]-Altropane™ (k3/k4) was calculated by the reference regionapproach as described by Farde, et al. to quantify [¹¹C]-raclopridebinding to dopamine D2 receptors. Farde, et al., 1989, J.Cereb.BloodFlow Metab 9:696-708. Briefly, specific binding to a receptor is afunction of the density of receptors (Bmax) and the dissociationconstant of the ligand (Kd). Specific binding of the ligand reaches amaximum during the time span of the imaging procedure. The time ofmaximal specific binding is determined from time activity curves (TAC)of specific and non-specific binding of the ligand. By assuming thatnon-specific binding is negligible in striatum and occipital cortex, thestriatal time activity curve (StrTAC) represents the kinetic behavior ofspecifically bound plus free ligand, while the occipital cortex TAC(OccTAC) represents the kinetic behavior of only free ligand. Underthese assumptions, the function, (StrTAC—OccTAC) defines the timedependence of bound ligand in the striatum. When this curve is fitted toa gamma variate function (A^(tn)e^(-mt)), and the maximum is divided bythe value of the occipital cortex TAC at the same time, an equilibriumestimate of (k3/k4) is obtained.

[0099] Reconstructed SPECT images were processed by the central readingfacility. Transaxial images containing the striatum were summed at eachtime point using standardized criteria. Regions of interest (ROIs) weredrawn around the left striatum, the right striatum, and a third ROI overthe occipital cortex. TAC¹s defined for average striatal and occipitalcortex activity were used to calculate the striatal binding potentialusing the following formula:

k3/k4=Max{StrTAC OccTAC}Time=t/{(OccTAC)}Time=t

[0100] The Binding Potential (BP) data collected from 24 patients wasanalysed. The results are tabulated below. TABLE 2 BPUncorrected-Adjusted to age of 28.4 years ALTROPANE™ DIAGNOSIS ADHDNon-ADHD Clinical Diagnosis (BP ≧ 2.75) (BP < 2.75) ADHD 6  2 Non-ADHD 214

[0101] TABLE 3 BP Corrected-Adjusted to age of 28.4 years ALTROPANE™DIAGNOSIS ADHD Non-ADHD Clinical Diagnosis (BP ≧ 2.90) (BP < 2.90) ADHD6  2 Non-ADHD 2 14

[0102] TABLE 4 Corrected BP No UCSD Non-ADHD ADHD 1.57 2.33 2.03 2.672.05 2.91 2.05 2.97 2.11 3.27 2.12 3.32 2.23 3.52 2.34 3.64 2.43 2.462.53 2.54 2.72 2.81 2.93 3.03 N 16 8 Average 2.37 3.08 Std Dev. 0.390.44 95% Cl 0.19 0.31 T test, one tail P = 0.0011 unequal variance

[0103] (¹²³I)-Altropane™ has been studied in several clinical trials inhealthy volunteers, patients with Parkinson's Disease, patients withnon-Parkinsonian movement disorders, and in adult patients with ADHD.(¹²³I)-Altropane™, at doses of 5-8 mCi, (8 mCi is equivalent to 14.4 ng,or 34 pmol Altropane™), has been used for the majority of studies. Theinjections have been well tolerated and no significant treatmentassociated adverse events have been reported among over 200 humansubjects studied to date.

[0104] The above study with single photon emission computed tomography(SPECT) using (¹²³I)-Altropane™ demonstrates good correlation betweenincreased striatal binding and the diagnosis of adult patients withADHD. Thus, it appears that the methods of the present invention, e.g.,using (¹²³I)-Altropane™ SPECT, can provide an independent and objectivediagnostic test that will complement the clinical diagnosis of ADHD.

EXAMPLE 3

[0105] Participants

[0106] 20 adults having ADHD and 20 age-matched healthy controlvolunteers were used in the study. The ADHD adults were from psychiatryoutpatient clinics and were required to meet the following inclusioncriteria: (1) meet full diagnostic criteria for both current andchildhood ADHD using DSM-IV criteria (American Psychiatric Association:Diagnostic and Statistical Manual for Mental Disorders (4th ed.).Washington, DC, American Psychiatric Association, 1994) as assessedduring a clinical interview employing a semi-structured interview formconducted by either a licensed clinical psychologist or psychiatrist;(2) absence of comorbid mood, oppositional defiant, conduct, and anxietydisorders and autism, or Tourette's syndrome; (3) no use of stimulantmedication within the prior month; (4) no recent illicit drug use byhistory and by urine drug screen obtained during the initial evaluation;(5) absence of history of significant head injury involving loss ofconsciousness, thyroid abnormalities, seizures, or brain surgery; (6) ascore <16 on the Hamilton Depression Scale (Hamilton M: A rating scalefor depression. J Neurol Neurosurgical Psychiatry 1960; 23:56-62) and<19 on the Beck Depression Scale; (Hamilton M, The assessment of anxietystates by rating. Brit J Med Psychol 1959; 32:50-55) (7) a score <21 onthe Hamilton Anxiety Scale; (Beck A, Ward C, Mendelson M: An inventoryfor measuring depression. Arch Gen Psychiatry 1961; 4:561-571) (8) agebetween 18 and 40 years; and (9) IQ score >75 as assessed bystandardized intelligence testing.

[0107] Control volunteers were obtained from advertisements placed inthe participating sites, regional newspapers, and known acquaintances ofthe investigators. These participants had to be of the same age as theADHD adults and demonstrate an absence of ADHD currently and inchildhood. This was established by having 3 or fewer inattention and 3or fewer hyperactive-impulsive symptoms both currently and in childhoodand by meeting no other criteria for ADHD from the DSM-IV as establishedby semi-structured interview (as above). All other exclusionary criterianoted for the ADHD group applied to this group as well. All femaleparticipants were required to have a negative urine pregnancy test takenon the day the scan was administered. Information from the participantselection criteria and demographic data is shown in Table 1. TABLE 1Demographic and initial subject selection information for each groupADHD Control Measure Mean SD Mean SD t p< Age (in years) 28.4 5.6 28.26.3 0.10 0.92 Reading (standard score) 103.5 7.7 108.4 12.1 1.57 0.13Spelling (standard score) 103.7 7.7 108.9 9.0 1.97 0.06 Math (standardscore) 102.8 14.6 103.0 12.0 0.04 0.97 # ADHD Symptoms 7.5 1.2 0.1 0.523.61 <0.0001 (current) Inattention # ADHD Symptoms 5.5 2.1 0.5 0.8 9.09<0.0001 (current) Hyperactivity Beck Depression Scale 7.5 4.3 1.0 2.15.61 <0.0001 (raw) Hamilton Anxiety Scale 3.2 3.1 0.8 1.3 3.00 0.0070(raw) Hamilton Depression Scale 3.0 3.2 1.2 2.0 2.03 0.0529 (raw)

[0108] Procedures

[0109] All participants were seen for three separate visits. During thefirst visit, written informed consent was obtained along with basicdemographic data and medical/surgical history. The Structured ClinicalInterview for DSM-IV disorders (SCID) (Spitzer RL, Williams J, Gibbon M,First M B: The Structured Clinical Interview for DSM-III-R (SCID). NewYork: Biometric Research Department, New York State PsychiatricInstitute, 1989) and the module for the disruptive behavior disordersfrom the Kiddie-Schedule for Affective Disorders and Schizophrenia(K-SADS-E) (Orvaschel H, Puig-Antich J: Schedule for Affective Disordersand Schizophrenia for School-age Children: Epidemiologic 4th Version.Ft. Lauderdale, Fla., Nova University Center for Psychological Study,1987) were then conducted and the rating scales collected (e.g.,Hamilton scales, Beck Depression Scale, and adult ADHD scales) (BarldeyRA, Murphy KR: Attention Deficit Hyperactivity Disorder: A ClinicalWorkbook. New York, N.Y., Guilford Publications, 1998). Eligibilitycriteria were then reviewed and established. Several neuropsychologicaltests were given. Blood and urine samples were collected along with a12-lead electrocardiogram. Participants were then given the SSKI orLugol solution to ingest orally 24 hours before their next scheduledappointment for the SPECT scan. Some ADHD adults had been takenprescribed stimulants for management of their ADHD. With theirphysician's permission, these participants were removed from theirmedication for a four-week period prior to being scheduled for theirSPECT scan.

[0110] During the second visit, scheduled for 1-5 weeks after theinitial visit, the SPECT scan was conducted. Participants were evaluatedat baseline for possible adverse events and all eligibility criteriawere reviewed once again. All were then queried about their having takenthe Lugol solution within the past 24 hours. Females then received aurine pregnancy test. Pre-injection vital signs and a brief neurologicalexam were conducted after which participants were positioned in thescanner. Over a 30 second period, the [¹²³I] altropane was infusedintravenously. A series of two-minute serial SPECT scans were thenobtained for 60 minutes after which vital signs were again tested, the12-lead ECG obtained again, and the brief neurological exam wasrepeated.

[0111] A third clinical visit was scheduled the following day at whichtime participants were interviewed about possible adverse events, aphysical exam was conducted, vital signs and the 12-lead ECG wererepeated, and a blood sample obtained.

[0112] SPECT Scan

[0113] While positioned horizontally in the scanner and [¹²³I] altropanewas injected. Serial two minute scans were acquired for a period of 60minutes.

[0114] Time activity curves (TAC) in the striatal regions (STR) werecompared with areas in the occipital cortex (OCC) to calculate the timedependence of bound [¹²³I] altropane STR minus OCC). These data were fitto a gamma variate function and divided by the maximum OCC TAC todetermine an equilibrium estimate of DAT binding potential(B_(max)/K_(d)). Measures of binding potential were then standardized toage 28.4 years for comparison between the ADHD and control groups.

[0115] Results

[0116] Forty subjects enrolled in the study (20/group). SPECT data weresuccessfully obtained from only 24 adults; 8 in the ADHD group and 16 inthe control group. Excessive head motion occurred in 7 cases andunreconstructable scans occurred in another 9 cases such that 16 of the40 original cases (12 ADHD and 4 controls) were eliminated from furtheranalysis. The mean age-corrected binding potential for the ADHD groupwas 3.08 (SD=0.45, 95% CI=0.38) while that for the control group was2.38 (SD=0.38, 95% CI=0.20). One-tailed t-test (unequal variance)revealed that the ADHD group had significantly greater binding potentialfor the [¹²³I] altropane than did the control group (p=0.0003).Regression analyses were conducted using the entire sample andpredicting age-corrected altropane binding potential. The contributionof each of the following list of independent variables was examinedseparately: number of inattention symptoms, number ofhyperactive-impulsive symptoms, reading, math, and spelling standardscores, Hamilton Depression Scale rating, Hamilton Anxiety Scale rating,and Beck Depression Scale rating. In the model for inattention andhyperactive-impulsive symptoms, age was included first. Then eachvariable was entered and the regression model analysis computed. For theremaining variables, both age and diagnostic category were enteredfirst, followed by the independent variable. The partial R square thatis reported represents the contribution the variable makes to the model,over and above age for the two ADHD symptom lists and age and diagnosticcategory for the remaining variables. The results were as follows:inattention: p=0.0008 (partial R²=40.4%), hyperactivity: p=0.0014(partial R²=37.5%), reading: p=0.06 (partial R²=9.51%), spelling: p=0.25(partial R²=3.74%), math: p=0.16 (partial R²=5.43%), HAM-D: p=0.96(partial R²=0.00%), HAM-A: p=0.76 (partial R²=0.27%), and Beck: p=0.31(partial R²=2.99%)). This series of analyses demonstrates that it isspecifically inattention and hyperactivity that are substantiallyrelated to [¹²³I] altropane binding potentials and not other frequentlycomorbid symptoms.

[0117] To determine the classification accuracy of the age-correctedbinding potentials, a BP cutoff score was selected as being +1 SD abovethe normal mean (2.76) for determination of ADHD diagnosis. Sensitivitywas determined to be 75% (6/8) while specificity was found to be 87.5%(14/16). Positive predictive power was 75% (6/8) while negativepredictive power was 87.5% (14/16).

[0118] The present results show increased dopamine transporter densityin striatum in adults with ADHD relative to an age-matched controlgroup. Adults with ADHD had 30 percent higher [¹²³I] altropane uptake instriatum than did control adults. Moreover, altropane binding potentialswere significantly related to degree of both inattention andhyperactive-impulsive symptoms, further solidifying the conclusion thatincreased dopamine transporter density is associated with the degree ofADHD symptoms within this sample. Regression analyses also demonstratedthat the comorbid levels of depression, anxiety, and academic learningabilities did not contribute significantly to these results once age andADHD diagnosis were controlled.

[0119] The invention has been described in detail including preferredembodiments. However, it will be appreciated that those skilled in theart may make changes and improvements within the spirit and scope ofthis invention.

What is claimed is:
 1. A method of diagnosing attention deficient-hyperactivity disorder (ADHD) in a human patient comprising assessing dopamine transporter in at least one region of said patient's central nervous system, wherein an elevated level of dopamine transporter in said patient is indicative of ADHD.
 2. The method of claim 1 wherein said assessment is by PET or SPECT imaging.
 3. The method of claim 1, further comprising administering to the patient a labeled dopamine transporter ligand and wherein the assessment comprises determining the amount of labeled dopamine transporter ligand that is bound to dopamine transporter.
 4. The method of claim 2, wherein the method further comprises the step of comparing the amount of labeled dopamine transporter ligand that is bound to dopamine transporter with a control.
 5. The method of claim 3, wherein the dopamine transporter ligand comprises a compound that binds to the dopamine transporter.
 6. The method of claim 3, wherein said dopamine transporter ligand comprises [¹¹C]CFT ([¹¹C]WIN 35,428).
 7. The method of claim 6, wherein said assessment comprises imaging by PET.
 8. The method of claim 3, wherein said dopamine transporter ligand comprises [¹¹C]altropane.
 9. The method of claim 8, wherein said assessment comprises imaging by PET.
 10. The method of claim 3, wherein said ligand comprises [¹²³I]altropane and said assessment comprises imaging by SPECT.
 11. The method of claim 3, wherein said ligand comprises a technetium-labeled phenyltropane probe.
 12. The method of claim 11, wherein said ligand comprises [⁹⁹mTc]technepine, O-1505.
 13. The method of claim 12, wherein said assessment comprises imaging by SPECT.
 14. The method of claim 1, wherein said at least one region of said patient's central nervous system comprises a portion of the brain.
 15. The method of claim 14, wherein said portion of the brain comprises the striatum.
 16. The method of claim 1, further comprising administering to the patient a labeled dopamine transporter ligand, the assessing step comprises assessing dopamine transporter availability, and the method further comprises comparing dopamine transporter availability with the dopamine transporter availability in a control, wherein a higher dopainine transporter availability in said patient is indicative of ADHD.
 17. The method of claim 1, further comprising administering to the patient a labeled doparnine transporter ligand, the assessing step comprises determining dopamnine transporter binding potential and the method further comprises comparing dopamine transporter binding potential with the dopamine transporter binding potential in a control, wherein a higher dopamine transporter binding potential in said patient is indicative of ADHD.
 18. A method of determining the effectiveness of an ADHD treatment for a human patient, the method comprising: a) assessing an initial dopamine transporter level in at least one region of said patient's central nervous system; b) applying the treatment; c) assessing a subsequent doparnine transporter level in said at least one region of said patient's central nervous system; and d) comparing the dopamine transporter level in step (a) with the dopamine transporter level in step (c), wherein a decrease in dopamine transporter levels indicates that the treatment is effective.
 19. The method of claim 18, further comprising administering to the patient a labeled dopamine transporter ligand before at least one of the assessing steps, and wherein the assessing comprises determining the amount of labeled dopamine transporter ligand that is bound to dopamine transporter.
 20. The method of claim 19, wherein the dopamine transporter ligand comprises a compound that binds to the dopamine transporter.
 21. The method of claim 18, wherein the second assessing step occurs two weeks or more after the applying step.
 22. The method of claim 18, wherein the treatment comprises a pharmaceutical treatment.
 23. The method of claim 18, wherein the pharmaceutical treatment comprises administration of a pharmaceutical selected from the group consisting of methylphenidate, pemolne, and an amphetamine.
 24. The method of claim 18, wherein the assessing step comprises PET or SPECT imaging.
 25. The method of claim 18, further comprising administering to the patient a labeled dopamine transporter ligand before at least one of the assessing steps, the assessing steps comprise assessing dopamine transporter availability, and the comparing step comprises comparing dopamine transporter availability in step (a) with the dopamine transporter availability in step (c), wherein a lower dopamine transporter availability in step (c) indicates that the treatment is effective.
 26. The method of claim 18, further comprising administering to the patient a labeled dopamine transporter ligand before at least one of the assessing steps, the assessing steps comprise assessing dopamine transporter binding potential, and the comparing step comprises comparing dopamine transporter binding potential in step (a) with the dopamine transporter binding potential in step (c), wherein a lower dopamine transporter binding potential in step (c) indicates that the treatment is effective.
 27. A method of determining whether an individual has a heightened probability of having ADHD, the method comprising: assessing doparnine transporter in at least one region of said patient's central nervous system; comparing said patient's dopamine transporter level to a normal dopamine transporter level, wherein a higher than normal level indicates a heightened probability of having ADHD.
 28. The method of claim 27, further comprising administering to the patient a labeled dopamine transporter ligand before the assessing step, and wherein the assessing comprises determining the amount of labeled dopamine transporter ligand that is bound to dopamine transporter.
 29. The method of claim 28, wherein the dopamine transporter ligand comprises a compound that binds to the dopamine transporter.
 30. A method of monitoring the progress of a treatment for ADHD in a human patient, the method comprising assessing dopamine transporter in at least one region of said patient's central nervous system a plurality of times during said treatment.
 31. The method of claim 31, further comprising administering to the patient a labeled dopamine transporter ligand before the assessing step, and wherein the assessing comprises determining the amount of labeled dopamine transporter ligand that is bound to dopamine transporter.
 32. The method of claim 31, wherein the dopamine transporter ligand comprises a compound that binds to the dopamine transporter.
 33. The method of claim 30, wherein the treatment comprises a pharmaceutical treatment.
 34. The method of claim 33, wherein the pharmaceutical treatment comprises administration of a pharmaceutical selected from the group consisting of methylphenidate, pemoline, and an amphetamine.
 35. The method of claim 34, wherein the assessing step comprises PET or SPECT imaging. 